Four in 10 Voters Want to Repeal Healthcare Reform

With just one week until the congressional election, 41% of those polled believe Congress should repeal the bulk of the major provisions in the healthcare reform law and replace them with a totally different set of laws, according to an analysis of an array of recent polls.

While four in 10 Americans polled would like a total repeal-and-replace, 31% would favor an option on the other end of the political spectrum: giving the federal government even greater control of the country's healthcare system, according to the analysis, published as an online Perspective in the New England Journal of Medicine.

Meanwhile, 18% of those polled would like to see Congress implement the version of the Affordable Care Act (ACA) signed by the president more than six months ago, according to the analysis, which was conducted by Robert Blendon, ScD, of Harvard School of Public Health and John Benson, MA, of the John F. Kennedy School of Government at Harvard.

Blendon and Benson examined results of 17 recent public polls -- including polls by Kaiser, Pew, Bloomberg, ABC, CBS, Harvard and others -- to determine what role healthcare issues might play in the Nov. 2 midterm elections. Most of the polls included in the analysis report on the views of the public as a whole, but others report on views of registered voters or people likely to vote in the midterm election.

Not surprisingly, the polls show a clear and substantial difference between Democrats and Republicans in their support of the ACA. Among those who plan on voting for a Democrat, nearly half want Congress to increase the government's role in healthcare and one-quarter would like to see the law implemented as is.

Among those who plan on casting their ballot for a GOP candidate, 71% favor repealing the law and replacing it with something new.

Overall, nearly three-quarters of those who said they'll vote for a Democrat support the new reform law, while 80% of those who are planning to vote for a GOP candidate said they oppose the legislation.

Blendon and Benson examined polling data to determine the current mood of the country and found that Americans have a negative view about the direction of the country and hold a largely anti-incumbent attitude toward Congress. Those views echo the collective mood of the country in 1994 and in 2006, when the incumbent party lost control of both houses of Congress.

Only 31% of those polled said they are inclined to vote to re-elect their current representatives.

Six in 10 believe the country is on the wrong track, while one-third think the nation is headed in the right direction.

But healthcare isn't the top issue on the minds of voters, according to Blendon and Benson. Their analyses of the polls show that healthcare is an important, but secondary, issue in this election. Topping the list is the economy and jobs.

However, more than seven in 10 respondents said a candidate's position on the ACA will play a role in how they vote, with 67% of Democrats saying they are more likely to vote for a congressional candidate who supported the new healthcare law, and 72% of Republicans saying they are less likely to vote for a candidate who supported the ACA.

While ACA's most popular provisions -- including ending discriminatory insurance industry practices, giving small business tax credits, and closing the so-called "doughnut hole" in Medicare -- enjoy broad support, a greater percentage of voters feel the U.S. economy will be worse off than better off under the new law, and the majority (56%) said they have little or no confidence that the government can solve the country's healthcare and medical problems.

More than half of those polled said if the GOP took control of both chambers, the party could repeal laws that passed in the past two years.

However, writing in a separate Perspectivein the Oct. 28 issue of NEJM, Henry Aaron, PhD, of the Washington-based Brookings Institution, said even if Republicans gain a significant number of congressional seats in the Nov. 2 election, immediate repeal of the ACA is highly unlikely. But a distinct and "troubling" possibility does exist that the results of the congressional midterm elections could severely stymie implementation of healthcare reform as Republicans seek to shut off the flow of funds needed in order to make the law work, Aaron wrote.

Aaron concludes that repeal of the ACA is unlikely before 2013 because a repeal bill would have to pass both chambers of Congress and the president would surely veto the legislation. It would require the support of two-thirds of each chamber to override the president's veto.

After 2012, repealing ACA could happen if a Republican president is elected and the GOP takes control of both the House and the Senate, Aaron wrote.

Aaron said a "more serious possibility" in the short term is that Republicans could attempt to block funding for ACA implementation by not approving appropriations bills related to the reform law.

The law contains over 100 authorizations to spend billions of dollars between 2010 and 2019, but Congress needs to enact appropriations bills in order to make that money flow.

"If ACA opponents gain a majority in either house of Congress, they could not only withhold needed appropriations but also bar the use of whatever funds are appropriated for ACA implementation, including the implementation of the provisions requiring individual people to buy insurance or businesses to offer it," Aaron wrote.

ACA opponents could also bar HHS from writing or issuing regulations relating to the ACA, or from engaging in any activity related to the creation of health insurance exchanges.

"The nation would then be left with zombie legislation," wrote Aaron, "a program that lives on but works badly, consisting of poorly funded and understaffed state health exchanges that cannot bring needed improvements to the individual and small-group insurance markets, clumsily administered subsidies that lead to needless resentment and confusion, and mandates that are capriciously enforced."

Blendon and Benson, and reported no financial conflicts of interest.

Aaron is employed by the Brookings Institution, and reported receiving money from Abt Associates, the Center for Public Policy Evaluation and Research, America's Health Insurance Plans, the National Blood Foundation, Children Health Care Association, American Health Information Management Association, Michigan Blue Cross/Blue Shield, and the Medicaid Managed Care Congress.

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